HomeMy WebLinkAbout1998-010815 - retaining walls �'ERMIT
CITY OF ORONO PERMIT TYPE:
�750 Kelley Parkway- P.O. Box 66 - - - ---
` C,''r stal Ba , Minnesota 55323 Permit Number: - -�`_ "- ' - - --
y y Date Issued: � -`-``=' `- -
(612) 473-7357 - - _
SITE ADDRESS:
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REMARKS:
FEE SUMMARY: �
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OWNER: _ - - ----- -
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ISSUED BY:SIGNATURE
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Total Fee: $ ��',=�'�` Date Received:
' Entered By: Permit#: �U �/S
CITY OF ORONO - BUILDING PERNIIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
-------------------------------------------------- ---=----------= ----- - - --------------------------------------
THE APPLICANT IS: (circle o e) � OWNER O�CONTRACTOR
�� _..��
JOB SITE ADDRESS: '����� -�'�c'�l.�L-r��� \�_�_�\\� ZIP: `_=>`�;�-�`�
����t- �-k������;i-�v i�;�PHONE: (home
NAME OF OWNER: { ) �-� � .\ZT�
� (work) �.������.
,
MAILING ADDRESS:���C�'l � ����;��:L�����_n CITY:��;�,���t: ZIP: �"���:
CONTRACTOR: i� �� PHONE:
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER � I� PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME; REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in det in: r��L�� �`�\5"C��\�=� \Z�.�\lU\\��s�
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�,_.�i---\--�._l_ ����_ 1 �..>��\� ,
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
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ESTIMATED CONSTRUCTION VALUATION (excluding land): $ �-���C�%
I hereby apply for a building permit and I acknowledge that the information above is complete and
accurate; that the work will be in conformance with the ordinances and codes of the City and with
the State Building Code; that I unde �nd this is not a permit and work is not to start without a
permit; and that the work will be ' acc ance ' the approved plan.
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APPLICANT'S SIGNATURE. �,; � '' DATE: � �Z_ �;
�
NOTE! Parade Qf Homes events require separate permit approval by Police Department and
Ciry Council 60 days prior to the event. Non permitted events will not be allowed.
Sec.13.04 RIGH'TS OF SUBJECTS OF D�1TA
Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set fotth in this secdon.
Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidenaal data conceming himself shall
be informed of: (a)the purpose and iatended use of the requested dara within the collecting'state agency, poliacal subdivision,or sratewide system;
(b)whether he may refuse oY is legally required to supply the requested data;(c)any Irnown consequence arising from tus supplying or refusing to supply
private or confidenaal data;and(d)the idenriry of ocher persons or enrides authorized by state or federal law to receive the data. This requ'uemenc shall
not apply when an individual is asked to suppty invesrieadve data, pursuanc to secdon 13.82, subdivision 5, to a law enforcement o�cer.
The commissioner of re�enue mav place the norice reauired under this subdivision in the individual income tax or propertv taz refund
instruc[ions inscead of on those forms.
Subd. 3. Access to data by indiridual. Upon request to a responsible auchoriry,an individual shall be informed whether he is the subject
of stored data on individuals,and whe[her it is classified as public, private or confidenrial. Upon his funher request, an individual who is the subject
of scored private or public data on individuals shall be shown the data wichout any charge to hun and, if he desires, shall be informed of the content
and meaning of�hat data. Afrer an individual has been shown the privace data and informed of i[s meaning,che data need not be disclosed to him for
six months thereafter unless a dispute or action pursuant to this secdon is pznding or addiaonal data on the individual has been collected or created.
The responsible authoriry shall provide copies of the private or public data upon requesc by the individual subject of the data. The responsible authoriry
may require the requesring person to pay che actual cosu of making, certifying, and compiling the copies.
The responsible authoriry shall comply immediately, if possible, wich any request made pursuant to this subdivision, or wi[hin five days of
the date of che requesc,excluding Saturdays,Sundays and lega]holidays,if immediace compliance is not possible. If he cannot comply with the requesc
within that time,he shall so inform the individual,and may have an addirional five days within which to comply with the request,excluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or comp(eteness of public or private
data concerning himself. To exercise this right,an individual shall nodfy in wridng the responsibie authoriry describing che nature of the disagreement.
The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attemp�to noafy past recipienu of
inaccurate or incomplete data, including recipients named by che individual; or(b)noafy the individual that he believes the data to be correct. Data
in dispute shail be disclosed only if the individual's statement of disagreement is included with the disciosed data.
The determinaaon of the responsible auchoriry may be appealed pursuanc to the provisions of the administradve procedure act reladng to
contested cases.
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd.2, "Rights of subjects of data", we would like to inform you that your request
for a permit or license from the City of Orono or any of its departments may require you to furnish certain private or
confidential information.
You are notified that:
1, The information you furnish will be used ro determine your qualification for the permit or license requested.
2. You may refuse to supply data, but refusal may require that the City deny the pemut or license.
3. The information may be shared with other local, state or federal agencies to the extent necessary to process
the pernut or license.
4. If your requested permit or license requires Council action to approve, some information may become
public.
5. You have certain rights under M.S. 13.04 (available upon request) to review private data on yourself.
6. Your full name is required to process this application or permit.
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E; Page 6 of 6
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CHECK OFF LIST FOR ISSUANCE OF PER.iIiiITS
, � FOR OFFICE USE ONLY
' ADDRESS OR LEGAL: _ �-1 (C�`� N l(��{ ,���o�J �.o A-►� � .
PID:
DES CRIPTTON OF WORK: i�;���,,N�, �,,,,��� � �
-- - ------------------------- ------
ZONIlYG REVIEti� BY: � DA'I'E APPROVED: � • Z,�- 5 8
BUII..DTNG REYI��V BY• � DATE APPROVED: � -L� -.�i.�0
. �___�___��_
, ---------------
k�ES TO BE C�iARGED: � � Misc. Fees Calculated By:
PERMIT Yes ✓ No '
PLAN REVIEW Yes No c/ SEWER CO�TNECTION
STATE SUR`H�1I'�Cr� Yes c/ No �ATER CO'vNECITON
17�tVESTIGATION-FEE Yes No PARK FEE
SAC Yes No SITEINSPECITON
Number of SAC Units OTHER (specify)
------------------------- ------ ----
Z0�1IIti'G CHECK LIST zoning District: /VU C (-�1NC,� .�
Fire Deparnnent: Post O ce: School District: �
Lot Area: Sq.ft. Acres tiVidtli Depth
Survey Submitted: Yes N Date of Survey:
Proposed Setbacks:
Froat (Lake): . Ri ht Side: �
Rear (Street): Le Side:
Adjacent Structures: SVetland:
Buildino Heiaht: Def. Hgt. Pea.k Hgt.
Lo[Coverage:
GradinJ: Staff Approval Date: � By: Council Approval Date:
Septic: Staff Approval Date: gy; • � .
Zoning File: � Resolution: # Resolution Date:� •
Shoreland Disc.-ict: � �
Avg. Setback: Blu Setback: Lot Coverage:
� ' E� � � Proposed �
Hardcover: 0-�5'
75-250' . . � �
250-500' . .
500-1000'
Hardcover Variance Required: Yes o Date of Council Approval:
. �
REIl�A�2K.S ('in house): �
�. � _ � . .
' ''' 26
. ��� . .
BUZI,D7NG REVIEti'V CHECK LIST � : ' . .
��: _ � �r� �ovS�U�ov�E: — - :
� Sq Foota�e $ Per Sq Ft�
Basement x �
. Ist Floor . � � X . . — _ . .
2nd Floor . . � .. . • . .x .. . . _ .
Gara;e , _ ' . . . .
x .
x .
TOTAL
Estimated Construction Value: �_�-('�--�o �- -
— Inspections Required: • Work Requiring Separate Permits:
Site Plumbin� �
Hazdcover Removal Fire . . _
Mechanical Water Connection
Footing Se tic � "
Framiao P Sewer Connection '
Fireplace Lawn IrriQati
Insulation a on
Wall Board ��O�Y) Other � � . .
_� g�� . (11'If�.) Well (State Permit) � �
Other Gradin�/Fillin� Electrical (State Permit)
. RE�i S (IN HOUSE): � ��_�---------- . ---_ ___---_
------------------ �
-------- DATE
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VIEtiV BY OTHERS: . - ------------
Access: Ezisci.n� � New � -
-----.
• Access Approval: Date .
--------------------------------- �y�
REiI�ARKS (TO BE NOTED ON PERitiIZT): R---� --�- -
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